I have tried unsuccessfuly to get pregnant for almost a year. I am a 32-year-old female and my husband is 35. What should we do?

The answer

With approximately a quarter of a million couples in Canada experiencing issues with fertility, you are not alone in dealing with this concern. This can be not only stressful for each individual involved but can also put a strain on your relationship.

Infertility is defined as a failure to conceive after one year of unprotected intercourse. Every person and every couple is unique and the causes for infertility may be due to female factors, male factors or a combination of both. Given that our natural fertility decreases with age and there is an increasing trend for delaying childbearing for social, professional and other personal reasons, infertility is becoming a common concern I see in my practice.

The reassuring news is that there may be a reversible cause that is interfering with your efforts to have a child and it is still possible that you may conceive in the next several months: 85 per cent of couples will become pregnant after 12 months of unprotected intercourse and over the next 36 months about 50 per cent of the remaining couples will go on to conceive spontaneously.

In your situation, I would suggest seeing your family doctor who can assist you in understanding what may be delaying conception and can refer you and your husband to a fertility specialist.

While every individual and couple is unique, the general consensus is to refer to a fertility specialist if the female is:

<35: after one year of trying for pregnancy

>35: after 6 months of trying for pregnancy

>40: as soon as requested by patients or by 6 months of trying

Possible causes of infertility in females include: difficulty ovulating (releasing an egg every month) due to possible hormonal imbalance, and anatomical issues such as blocked fallopian tubes which may be due to endometriosis, previous pelvic surgery, pelvic inflammatory disease or radiation/chemotherapy.

For males, possible causes include decrease sperm production or sperm abnormalities which may be due to infection (sexually transmitted infection, mumps), trauma to the genital area, or radiation/chemotherapy.

While you are waiting to see your doctor or fertility specialist, a few tips to consider to prepare yourself for a healthy pregnancy and to improve the chances of conception include:

1. Quit smoking and limit alcohol consumption: Women who smoke are approximately three times more likely to experience a one year delay in conception compared to a nonsmoker.

Alcohol can have negative affects on pregnancy and on the fetus, so while trying to conceive it is best to avoid or limit alcohol use.

2. Aim for a healthy weight: Being underweight or overweight can influence fertility and affect ovulation and sperm quality.

3. Take prenatal vitamins: Find one that contains at least 0.4-1.0mg folic acid which helps to reduce neural tube and other birth defects.

4. Have sex regularly: While this seems like an obvious suggestion, having regular intercourse every other day is found to be optimal to increase chances of conception. Daily sexual activity has not been found to be more effective and too frequent ejaculation can actually decrease sperm quality. Use of lubricants such as petroleum jelly or oils can affect sperm motility, so if you need it there are 'pre-seed' lubricants that can be used that do not negatively affect sperm.

5. Consider doing an ovulation calendar: Check in with your doctor about ways to track when you're ovulating with temperature and ovulation kits so you can time intercourse for the optimal time

6. Manage stress: Easier said than done but it has been found that stress may interfere with hormonal balance needed for ovulation and sperm production.

7. Optimize sperm quality and production: Avoid overheating the testes (frequent use of hot tubs/saunas/tight fitting underwear), and limit marijuana and cigarette smoking as these have been found to impair sperm production.

Infertility can cause severe emotional stress and often people describe a cycle of 'hope and despair' when it comes to waiting every month to see if they have concieved. For extra emotional supports, there are excellent resources in communities across Canada. Your family doctor may be able to suggest some local groups or a good resource is the
Infertility Awareness Association of Canada, which provides coast to coast support groups.

Send family doctor Sheila Wijayasinghe your questions at
doctor@globeandmail.com. She will answer select questions, which could appear in The Globe and Mail and/or on The Globe and Mail web site. Your name will not be published if your question is chosen.

The content provided in The Globe and Mail's Ask a Health Expert centre is for information purposes only and is neither intended to be relied upon nor to be a substitute for professional medical advice, diagnosis or treatment.

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